There is an old joke about a German sub during WW II which lost its ability to navigate, no data. It went; the Captain sent a message to the crew that they were to surface. However, they all knew they had lost their navigator and were sailing in the dark, say to tell. The Captain said: "I have good news and bad news. The good news is we may be surfacing in Buenos Aires harbor. The bad news is it may be New York City."
The joke is a truism, namely you don't know where you are going without data. COVID has been driven to Scylla and Charybdis due to the lack of reliable and timely data. Science writes a piece laying the blame on Dr. Birx[1]. In my opinion, she tried to fix what may be an unfixable problem often caused by the very Government itself. This Science piece is just another hit piece by the left-wing media, yes indeed. One must remember that Science was headed for a long while by a former New Jersey Congressperson. Not an arm's length relationship.
The Science article states:
…a top aide to White House Coronavirus Task Force Coordinator Deborah Birx, chaired the meeting. Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Prevention’s (CDC’s) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birx’s demand that hospitals report 100% of their COVID-19 data every day…
Now what is the real problem? In my opinion, it is simple, if one is trying to control a pandemic one needs timely and accurate data. Who is infected, where, when, and the like. The data must be timely, namely what one gets today is what was actually recorded yesterday. It must reflect demographic data adequate for tracking, if such be the case. Now based upon my seven months of daily tracking in New Jersey the data is notoriously corrupted. LTC never reports on weekends thus seeing spikes in the data. Infections are reported which are highly suspicious. Deaths are recorded with patients having multiple underlying problems who most likely would have dies otherwise. Bottom line, the State data is often useless. It may have gotten a bit better but State Public Health is after all just another group of State employees.
So where does or did the CDC fit in? Frankly from the beginning, nowhere. Their data was in my opinion and in my experience inaccessible and useless!
Now Science continues the attack on Birx. The reality was that Birx clearly knew the criticality of data and that the CDC had been grossly incompetent in gathering and disseminating the data. The hit piece then states:
CDC employees with whom Science spoke—who requested anonymity because they fear retaliation—along with other public health leaders, say Birx’s actions, abetted by a chaotic White House command structure and weak leadership from CDC Director Robert Redfield, have contributed to what amounts to an existential crisis for the agency. And her disrespect for CDC has sent morale plummeting, senior officials say. During a May task force meeting, The Washington Post reported, Birx said: “There is nothing from the CDC that I can trust.”…
The statement has a great deal of merit. The clear evidence was the CDCs lack of an operational plan, the incompetent execution of testing, and the gross failure to address the pandemic when it was well known even in mid-January! The article continues:
Agency insiders concede that CDC’s National Healthcare Safety Network (NHSN)—the system used for 15 years to gather crucial data from hospitals—was far from perfect. The network, which collects data from about 37,000 hospitals and other health care facilities, has been underfunded for years. All the same, five times weekly, NHSN reliably produced actionable COVID-19 data such as available hospital beds, intensive care occupancy, and ventilators used, according to CDC sources and internal reports obtained by Science. CDC staffers used long-tested statistical algorithms to impute missing data….
This is in my opinion another understatement. I tried on multiple occasions to access the data to no avail. The New jersey data was accessibly every day, no five day routine like the lazy CDC. A pandemic is an all hands on deck action, forget Saturday and Sunday folks. The Science piece continues:
Birx’s imperative of 100% of hospital data every day has proved elusive. The Department of Health and Human Services (HHS) data hub for hospital capacity, including inpatient beds occupied overall and by COVID-19 patients, now draws on data collected by TeleTracking, a for-profit company with nearly 400 employees, and on data submitted by state health departments and hospital associations. As with NHSN, nearly all data are collected manually rather than automatically from electronic patient records. Some hospital associations and health departments combine data from hospitals into spreadsheets and send them by fax or email to HHS. TeleTracking also offers a web interface for hospitals or their contractors to enter data.
Yes indeed the data is corrupted by inconsistent and highly error prone methods. As anyone knows who has dealt with hospitals, even the best of University related hospitals the MIS and data folks and decades behind and getting data is akin to the proverbial extraction of hen's teeth. It is not only hospitals but the needs to test and report. CDC was initially relied upon for testing and in my opinion they grossly failed. That was problem number one. Then everything else was catch up. We are still playing catch up.
Just look at the disease cycle. Someone gets infected. It takes a week before symptoms, three days before testing, three days to get the result and thus an infected person is spreading the virus for almost two weeks! Then the data gets reported and finally sent to a master database. The result is a delay which will make any control system grossly unstable. One can just look at the Lakewood NJ mini pandemic. We knew it would happen and it took more than a week to sound the alarm. A proper data collection system is critical but after decades CDC has done nothing to implement it. Birx tried to repair the wings of a stricken aircraft while flying at 40,000 feet! The hit piece continues:
The underlying data tables are updated daily but run 3 to 4 days behind—less efficient than NHSN before it ceased operating. CDC officials and public health experts blame several factors for those problems: Hospitals aren’t used to TeleTracking’s system and the additional data points (such as age) added work. Also, TeleTracking has long-standing relationships with fewer hospitals than NHSN; such relationships can speed troubleshooting.
Reporting to CDC works with reportable STC, rabies, Ebola and more classic results. A three day delay in a rabies report is not a serious problem since the patient is being treated. Three to four days with STC is not that bad nor is HIV in today's world.
It is regrettable that this hit piece is an ad hominem attack and fails to address the true scientific issue. What should be measured, how, when, by whom, etc. This is as simple problem but one of scale. Moreover, the data MUST be transparent and publicly available. Unlike prior times we now have many competent individuals and groups whose analysis of the data can be complementary. The CDC had a long history of deliberately making their data inaccessible and grossly lacking in transparency.
Regrettably this article seems politically motivated and missed the opportunity to define the problem, suggest solutions and help remediate what in my opinion is a broken organization.
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